从四起SARS爆发案例分析SARS的流行病学特征

目的探索SARS的可能来源、流行特征、传播途径与预防对策。方法对广西的2起早期SARS案例进行流行病学调查,对北京某家庭SARS案例和报刊介绍的北京一宗SARS案例收集有关流行病学资料,用流行病学方法和因素分布理论结合免疫学原理对其传播链进行解剖分析和演绎推理。结果广西的两宗早期病例分别存在动物或野生动物接触史。4起爆发案例均呈家庭和特殊职业聚集性,其二代病例以近距离飞沫和密切接触传播为主,但也可能存在血传播和性传播。结论SARS很可能为自然疫源性疾病,除传播途径为近距离飞沫和密切接触传播外,显性感染者的潜伏期或隐性感染可通过性传播而形成隐匿传播。SARS的预防策略为禁止捕杀野生动物,加强疫情报告与监测,做到早发现、早报告、早隔离、早治疗、早调查处理,同时做好医护人员防护和避免院内交叉感染以及切断隐匿传播途径的综合性预防措施。     

湖北省SARS疫情监测与病人发现措施效果评估

目的 评估和探讨湖北省严重急性呼吸系统综合征(SARS)疫情监测和病人发现措施的效果。方法 调查、收集2003年4月11日～7月9日全省各地疫情监测和病人发现的有关资料和数据，分析比较措施的预防效果。结果 各类监测点中，以社区卫生服务站和村卫生室监测点的发热病人检出率最高，分别为2．024％和0．72％。各级医疗机构发热门诊共发现发热病人240949例，初诊为SARS85例，上感160948例，流感13679例，普通肺炎14082例，结核1414例，其他45518例，留验观察8823例；发热病人占监测人数的0．94％，SARS病人占发热病人的0．036％。占监测人次总数的0．0006％。结论 SARS期间采取的疫情监测和病人发现措施效果显著，有效地阻断了传染源，无疫情扩散。发热病人门诊应作为控制SARS的常规措施。     

SARS早期预警监测试点项目结果分析

目的 对广东省佛山市顺德区第一医院开展SARS早期预警监测试点项目中的门诊病人监测结果进行评价。方法 于2003年12月10日-2004年1月10日，对该医院内科门诊、内科急诊及发热门诊病人进行监测，按卫生部及中国疾病预防控制中心制定的监测病例定义和预警指标进行诊断。结果 共监测就诊病人23045人次，发现发热呼吸道病例101例，占监测总数的0．44％；发热肺炎病例19例，占监测总数的0．08％；未发现SARS预警病例。结论 完善的监测系统，可及时发现发热呼吸道病人及发热肺炎病人，确认或排除SARS疫情，及时有效的采取公共卫生防控措施。     

SARS outbreak, Taiwan, 2003

We studied the severe acute respiratory syndrome (SARS) outbreak in Taiwan, using the daily case-reporting data from May 5 to June 4 to learn how it had spread so rapidly. Our results indicate that most SARS-infected persons had symptoms and were admitted before their infections were reclassified as probable cases. This finding could indicate efficient admission, slow reclassification process, or both. The high percentage of nosocomial infections in Taiwan suggests that infection from hospitalized patients with suspected, but not yet classified, cases is a major factor in the spread of disease. Delays in reclassification also contributed to the problem. Because accurate diagnostic testing for SARS is currently lacking, intervention measures aimed at more efficient diagnosis, isolation of suspected SARS patients, and reclassification procedures could greatly reduce the number of infections in future outbreaks.     

湖北省防治传染性非典型肺炎各类监测方式的成本-效益分析

目的研究效果好、成本低、科学合理的监测方法,为政府决策提供依据。方法计算成本-效益比值,对各类SARS监测站进行横向比较。结果平均检出1例发热病人的费用,医疗机构发热门诊为1 649元,村卫生室监测点5 044元,社区卫生服务站8 807元,留验站9 416元,交通监测点99 127元。结论医疗机构发热门诊、村卫生室监测点和社区卫生服务站应作为今后控制SARS和其他传染病的常规监测方式,不再设立交通检测点和留验站,以节省经费。     

SARS后发热门诊护理管理

目的成立并完善发热门诊的管理,对待排的传染病病例进行隔离医学观察,控制传染病传播。方法从发热门诊的布局、分区、功能;护理人员管理;工作制度和工作流程管理及患者管理等方面综述了发热门诊的管理现状。结果严格并完善发热门诊的管理,对传染病特排的病例进行隔离,医学观察是控制传染病传播的重要措施之一。结论发热门诊科的设立正是防控SARS疫情等烈性传染病,控制传染源至关重要的环节。     

Severe acute respiratory syndrome, Beijing, 2003

The largest outbreak of severe acute respiratory syndrome (SARS) struck Beijing in spring 2003. Multiple importations of SARS to Beijing initiated transmission in several healthcare facilities. Beijing's outbreak began March 5; by late April, daily hospital admissions for SARS exceeded 100 for several days; 2,521 cases of probable SARS occurred. Attack rates were highest in those 20-39 years of age; 1% of cases occurred in children <10 years. The case-fatality rate was highest among patients >65 years (27.7% vs. 4.8% for those 20-64 years, p < 0.001). Healthcare workers accounted for 16% of probable cases. The proportion of case-patients without known contact to a SARS patient increased significantly in May. Implementation of early detection, isolation, contact tracing, quarantine, triage of case-patients to designated SARS hospitals, and community mobilization ended the outbreak.     

SARS in hospital emergency room

Thirty-one cases of severe acute respiratory syndrome (SARS) occurred after exposure in the emergency room at the National Taiwan University Hospital. The index patient was linked to an outbreak at a nearby municipal hospital. Three clusters were identified over a 3-week period. The first cluster (5 patients) and the second cluster (14 patients) occurred among patients, family members, and nursing aids. The third cluster (12 patients) occurred exclusively among healthcare workers. Six healthcare workers had close contact with SARS patients. Six others, with different working patterns, indicated that they did not have contact with a SARS patient. Environmental surveys found 9 of 119 samples of inanimate objects to be positive for SARS coronavirus RNA. These observations indicate that although transmission by direct contact with known SARS patients was responsible for most cases, environmental contamination with the SARS coronavirus may have lead to infection among healthcare workers without documented contact with known hospitalized SARS patients.     

Public health measures implemented during the SARS outbreak in Singapore, 2003

The SARS outbreak hit Singapore between March and May 2003. Public health control measures were applied along three fronts; prevention and control within healthcare settings, community and at the borders. Nosocomial spread composed majority of SARS cases in Singapore. To prevent infection within healthcare facilities, cases were centralized in a SARS-designated hospital, a no-visitors rule was applied and movement of patients and healthcare staff were restricted. For triaging purposes, fever clinics were established. A dedicated ambulance service was used to transport possible cases to the SARS-designated hospital. Hospitals were surveyed for fever clusters. The challenge was to identify cases with atypical presentation. Effective and safe discharge criteria were established from the lessons learnt. To prevent community spread, contacts of cases were stringently traced, quarantined in their homes and monitored daily. For prompt identification of a case and to reduce the time between onset of symptoms and isolation, the Infectious Diseases Act was amended. A large wholesale market closure resulted in massive quarantine thereby limiting the spread of infection. A mass education campaign was implemented in order to educate and raise awareness of the public. At all air, sea and land points-of-entry, exit and entry screening took place that resulted in zero importation and exportation of SARS cases after implementation of screening. Coordinated effort of the cross sectional inter-ministerial collaboration and strong coordination by the Task Force and commitment from different professionals made it possible to conquer the disease.     

北京市后SARS时期发热门诊现状和合理设置模式的研究

目的 研究SARS疫情解除后北京市发热门诊设置和功能执行上存在的问题，提出合理的设置模式。方法 采用定量和定性调查相结合的方式。定量调查包括(1)后SARS时期18区县各发热门诊设置和运行方式的调查，调查对象为北京市所有现存的63家医院发热门诊的管理人员。(2)发热门诊就诊的发热患者的整群抽样调查。(3)在发热门诊工作的医生的调查。定性调查包括：北京市发热门诊负责人调查、北京市18区县分层随机抽取的23家不同级别医院主管领导、发热门诊负责人及发热门诊工作的医生个人或小组访谈和实地考察，未设置发热门诊的医院中随机抽取了28家进行了电话调查。结果SARS疫情解除后，这种仍然以集中就诊的方式对一种疾病进行长期常规监测的系统存在如下问题：(1)监测网覆盖率低。全市89％的医院和所有的门诊部均未在监测范围内，而未设发热门诊的医院和门诊部已逐渐自发的接受发热患者。但无规范化的管理和完善的信息系统支持。(2)目前建立的SARS监测信息系统对SARS疫情的监测功能尚可，但对发热病例监测的信息准确性、完整性存在明显问题，实名制未真正实施。(3)多数发热门诊的人力物力投入和就诊病例的数量明显不成比例，造成不同程度的医疗资源利用不足，特别是发热定点医院的投入和产出差别极大，医疗资源浪费严重。结论 根据研究发现的问题和分析，对今冬明春发热门诊的设置方式提出了建议，同时对其长期发展提出了建议。     

Domestic poultry and SARS coronavirus, southern China

SARS coronavirus injected intratracheally into chickens, turkeys, geese, ducks, and quail, or into the allantoic sac of their embryonating eggs, failed to cause disease or replicate. This finding suggests that domestic poultry were unlikely to have been the reservoir, or associated with dissemination, of SARS coronavirus in the animal markets of southern China.     

广西重点人群传染性非典型肺炎监测研究

目的为了及时发现和监控传染性非典型肺炎病例,防止疫情扩散和蔓延,探讨影响疫情发生和发展的因素.方法采用主动与被动相结合的疾病监测方法,在全区范围内对从外地返乡、来桂人群、非典病人密切接触者、发热病人实施监测.结果自2003年4月15日至2003年7月10日,全区组织1076万日人次参与重点人群监测,共监测排查从外省(市)返乡人员625 646人,其中从广东返乡501 596人,累计发现发热病人7067人,确诊为非典病例6例;监测来桂人群201 158人,其中从广东来51 288人,发现发热病人981人,未查出非典病例;隔离观察非典密切接触者2213人,发现非典2例,发病率达90.4/10万;发热门诊接诊709 843例发热病人,其中有3例确诊为非典病例也系返乡民工.结论通过这次大范围监测,广西自4月中旬以后发生的11例非典病人均能在第一时间(48h内)得以发现和监控,有效防止了疫情扩散和蔓延.监测结果还表明广西尚属输入性地区,未发生流行,受到邻省疫情威胁不很严重;同时显示一些市(县)开展人群监测有一定程度过度反应,付出的代价昂贵,急需建立起更高效经济可行适合常态管理的监测手段.     

张家界市76例新型冠状病毒Delta变异株感染病例的临床特征

 目的 分析新型冠状病毒（SARS-CoV-2） Delta变异株感染病例的临床特征,为Delta感染病例的防治提供参考依据。方法 回顾性分析2021年7—8月湖南师范大学附属张家界医院收治的76例SARS-CoV-2变异株Delta感染病例的临床特征。结果 本次疫情涉及17个家庭,8个工作环境和场地中的76例感染者,平均年龄为（34.7±18.1）岁,高发于15~49岁人群。无症状感染者4例（5.26%）,轻型17例（22.37%）,普通型50例（65.79%）,重型4例（5.26%）,危重型1例（1.32%）;76例Delta感染者中SARS-CoV-2核酸最低Ct值N值17.5,Lab值16.25,平均SARS-CoV-2核酸持续阳性时间为34.5 d,其中23例出院7 d后再次出现SARS-CoV-2核酸Ct值阳性。主要临床表现为发热和咳嗽。感染早期98.68%的患者血常规中白细胞计数正常或降低,11.84%患者天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）出现轻度升高,少数患者肌酐和心肌酶出现异常;血沉（ESR）、降钙素原（PCT）和C反应蛋白（CRP）升高的比率分别为58.21%、5.26%和31.58%。其中55例（73.37%）出现肺部病变,以沿胸膜下分布的磨玻璃样影改变为主要影像学特点,部分病例合并胸腔积液和实变。结论 Delta感染者体内病毒载量高,核酸转阴时间长,主要临床表现为发热、咳嗽,早期可伴AST/ALT升高。     

佛山地区重症SARS病例存在抗SARS冠状病毒抗体

目的：求证佛山地区首批临床诊断的SAILS患者血清中是否存在抗SARS冠状病毒抗体。方法：以SARS冠状病毒全病毒裂解液作抗原，利用ELLSA技术检测佛山地区首批出现急性呼吸窘迫综合征并具有明显传染特征的SARS康复患者和患者居住地“健康者”血清中抗SARS冠状病毒抗体。结果：4组有流行病学关系的19例SARS患者血清中抗SARS冠状病毒抗体全部阳性，而400名患者居住地的“健康者”血清中抗SAILS冠状病毒抗体则全部阴性。结论：佛山地区首批SARS病例血清学调查结果发现在所有的患者血中均发现有抗SAILS冠状病毒抗体，支持其病原体为SARS冠状病毒；抗SARS抗体IgG在ESARS康复者血清中至少可存在6个月。     

安徽省SARS定点医院和发热门诊消毒剂使用情况调查

目的　了解我省SARS定点医院和发热门诊消毒剂使用情况。方法　对我省 5座城市 1 6所SARS定点医院和发热门诊的消毒剂采购、索证、配制、使用进行调查。并随机抽取使用的消毒剂 ,对其有效成分含量进行检测。结果　抽检 35份消毒剂 ,合格 1 9份 ,合格率 5 4 .2 9%。其中 ,过氧乙酸合格率仅为 35 .71 % ;医院对消毒剂索证管理合格率为 6 2 .5 0 % ;医院使用的消毒剂中 ,假冒、伪劣产品占 31 .4 3%。结论　我省SARS定点医院和发热门诊消毒剂使用情况不容乐观 ,医务人员对消毒剂的使用知识匮乏 ,有必要进行相应业务和技术的培训 ,以提高医院的消毒水平     

Infrared thermography to mass-screen suspected SARS patients with fever

Fever greater than 38 degrees C is a cardinal sign of patients with the severe acute respiratory syndromes (SARS). To reduce the risk of nosocomial cross infections, screening all patients and visitors who visit hospitals and clinics for fever at the entrance of every hospital building has become a standard protocol in Taiwan during the SARS epidemic from mid-April to mid-June 2003. We used a digital infrared thermal imaging (DITI) system (Telesis Spectrum 9000 MB) to conduct mass screening of patients and visitors who entered the hospital to identify those with fever. The DITI system has two components: a sensor head and a PC imaging workstation. The sensor head is an optic-mechanical device which consists of imagining optics for focusing the infrared source information on the infrared detector. The infrared images are further converted into electrical signals, which are then processed for real-time display on the monitor. During the period from April 13 to May 12 2003, 72,327 outpatients and visitors entered Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. A total of 305 febrile patients (0.42%) was detected by infrared thermography. Among them, three probable SARS patients were identified after thorough studies including contact history, laboratory tests and radiology examinations. The findings suggests that infrared thermography was an effective and reliable tool ideal for mass-screening patients with fever in the initial phase of screening for SARS patients at a busy hospital which sees approximately 3,000 outpatients every weekday during the SARS epidemic.     

Epidemiologic clues to SARS origin in China

An epidemic of severe acute respiratory syndrome (SARS) began in Foshan municipality, Guangdong Province, China, in November 2002. We studied SARS case reports through April 30, 2003, including data from case investigations and a case series analysis of index cases. A total of 1,454 clinically confirmed cases (and 55 deaths) occurred; the epidemic peak was in the first week of February 2003. Healthcare workers accounted for 24% of cases. Clinical signs and symptoms differed between children (<18 years) and older persons (> or =65 years). Several observations support the hypothesis of a wild animal origin for SARS. Cases apparently occurred independently in at least five different municipalities; early case-patients were more likely than later patients to report living near a produce market (odds ratio undefined; lower 95% confidence interval 2.39) but not near a farm; and 9 (39%) of 23 early patients, including 6 who lived or worked in Foshan, were food handlers with probable animal contact.     

建设发热门诊增强防御SARS能力

SARS疫情发生后，医院在没有传染科的条件下，先后建立了临时发热门诊和独立发热门诊及隔离病区。由于新建的发热门诊布局合理、功能齐全、设备配套、流程严密、制度规范，有效地防止了疫情在医院的传播。发热门诊诊治患者1512人次，留观85人，实现了SARS防治5个零的防疫目标。提出综合医院防治SARS在医院建筑上应注重功能和卫生学要求，在人才培养上应加强传染病基本技能培训，在医院感染监控上要做好防疫物资储备，以提高应对SARS疫情的能力。     

SARS transmission among hospital workers in Hong Kong

Despite infection control measures, breakthrough transmission of severe acute respiratory syndrome (SARS) occurred for many hospital workers in Hong Kong. We conducted a case-control study of 72 hospital workers with SARS and 144 matched controls. Inconsistent use of goggles, gowns, gloves, and caps was associated with a higher risk for SARS infection (unadjusted odds ratio 2.42 to 20.54, p < 0.05). The likelihood of SARS infection was strongly associated with the amount of personal protection equipment perceived to be inadequate, having <2 hours of infection control training, and not understanding infection control procedures. No significant differences existed between the case and control groups in the proportion of workers who performed high-risk procedures, reported minor protection equipment problems, or had social contact with SARS-infected persons. Perceived inadequacy of personal protection equipment supply, infection control training <2 hours, and inconsistent use of personal protection equipment when in contact with SARS patients were significant independent risk factors for SARS infection.